Provider Demographics
NPI:1568277994
Name:NUTRITION AVENUE LLC
Entity type:Organization
Organization Name:NUTRITION AVENUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OCASIO DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:LND
Authorized Official - Phone:787-559-4801
Mailing Address - Street 1:302 CARR. #3 KM 82.5
Mailing Address - Street 2:HUMACAO SHOPPING PLAZA
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4713
Mailing Address - Country:US
Mailing Address - Phone:787-559-4801
Mailing Address - Fax:
Practice Address - Street 1:302 CARR. 3 KM 82.5
Practice Address - Street 2:HUMACAO SHOPPING PLAZA
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4713
Practice Address - Country:US
Practice Address - Phone:787-559-4801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty